Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Case Report

Volume 11, Number 3, June 2018, pages 241-246

Denture-Associated Oral Microbiome and Periodontal Disease Causing an Anaerobic Pyogenic Liver Abscess in an Immunocompetent Patient: A Case report and Review of the Literature

Figures

Figure 1.
Figure 1. CT with contrast showing multiple hypoattenuating lesions in the liver (dashed line).
Figure 2.
Figure 2. MRI with contrast demonstrating multiple hepatic cystic lesions with enhancing septa (arrows) and marked diffusion restriction (lesions are hypointense on apparent diffusion coefficient (ADC) and hyperintense on diffusion-weighted imaging (DWI) compatible with abscess).
Figure 3.
Figure 3. Panorex demonstrating multiple missing teeth with lucency around the root of a left mandibular premolar (arrow), likely representing a periapical abscess.
Figure 4.
Figure 4. CT with contrast showing interval decrease in rim enhancing fluid collections at 10 weeks (dashed line).

Tables

Table 1. Laboratory Data: Hospitalization Days 1, 28 and 64
 
Test (normal range)Day 1Day 28Day 64
WBC, white blood cell; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase.
WBC (3.5 × 103 - 10.5 × 103/µL)28.57.65.4
Albumin (3.4 - 5 g/dL)2.72.93.2
ALT (0 - 55 units/L)1172917
AST (5 - 34 units/L)882820
ALP (40 - 150 units/L)17918287
Total bilirubin (0.2 - 1.2 mg/dL)1.60.40.4

 

Table 2. Case Reports of Immunocompetent Patients With Pyogenic Liver Abscess Caused by Fusobacterium
 
Age (years old) SexPresentationImagingAssociated infectionOrganismsTreatmentPrognosis
RUQ: right upper quadrant; US: ultrasound; CT: computed tomography; IV: intravenous; PLA: pyogenic liver abscess; VATS: video-assisted thoracoscopic surgery.
Crippin et al 1992 [3]69 M3-week history of fever and malaiseCTDental disease, molar abscessFusobacterium nucleatumPercutaneous drainage and IV antibiotics for unknown duration. Dental surgery following hospitalizationNo recurrence in 72 months of follow-up
Memain et al 2001 [21]24 F3 months of diarrhea and feversUS & CTTonsil infection, sepsisFusobacterium nucleatumMetronidazole and fluoroquinolone for 4 weeks. Tonsillectomy was performed without any histological abnormalityRapid improvement with antibiotics treatment and intensive care. Follow-up course unknown
Kajiya et al 2008 [22]59 MFever, chills, malaiseUS & CTDental caries, poor dental hygieneFusobacterium nucleatumImipenem/cilastatin, due to sensitivities changed to clindamycin (unknown durations). Patient refused percutaneous drainageFull resolution of abscess on CT and US after 1 month
Fatakhov et al 2013 [23]30 MSeveral days of fevers, chills, malaise, nausea, vomiting, diarrheaUS & CTNoneFusobacterium necrophorumPercutaneous drainage. Metronidazole and piperacillin/tazobactam for 8 days, narrowed to levofloxacin and metronidazole until abscess resolved on imaging (2 weeks post-drainage)Abscess was resolved on CT at 2 weeks after drain insertion
Nagpal et al 2015 [24]69 F2-month history of vague RUQ pain, fevers and chillsUS & CTSevere chronic periodontitis
Diverticulitis		Fusobacterium nucleatumPercutaneous drainage. Vancomycin (stopped after 3 days) and meropenem, later changed to ertapenem for total of 2 weeks. Discharged on oral penicillin for 4 weeksFull resolution on repeat CT at 4 months post-discharge
Ahmed et al 2015 [2]21 M2 weeks of RUQ pain, fevers, chills, weight loss, fatigue, diarrheaCTRecent routine dental cleaning.
Complicated by sepsis, empyema,
abdominal and pelvic abscesses		Fusobacterium nucleatumEmpiric vancomycin and piperacillin/tazobactam for unknown duration, treated with IV ertapenem for 8 weeks. Percutaneous drainage of PLA.
Required VATS procedure for trapped lung.
Drainage of abdominal and pelvic abscesses		Resolution of abscesses on CT after 9 weeks of treatment